Citation Nr: 1042467 Decision Date: 11/10/10 Archive Date: 11/18/10 DOCKET NO. 05-38 130 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas THE ISSUE Entitlement to service connection for peptic ulcer disease. REPRESENTATION Appellant represented by: Texas Veterans Commission ATTORNEY FOR THE BOARD D. Schechner, Associate Counsel INTRODUCTION The appellant is a Veteran who served on active duty from May 1951 to May 1953. This matter is before the Board of Veterans' Appeals (Board) on appeal from a February 2006 rating decision of the Waco, Texas VARO. In December 2009, the Board remanded this matter for additional development. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2010). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDING OF FACT Peptic ulcer disease was not manifested in service, or in the first year following the Veteran's discharge from active duty, and such disease is not shown at any time during the pendency of this claim. CONCLUSION OF LAW Service connection for peptic ulcer disease is not warranted. 38 U.S.C.A. 1110, 1112, 1113, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2010). REASONS AND BASES FOR FINDING AND CONCLUSION Veterans' Claims Assistance Act of 2000 (VCAA) The Board is required to ensure that the VA's "duty to notify" and "duty to assist" obligations have been satisfied. See 38 U.S.C.A. §§ 5103, 5103A (West 2002); 38 C.F.R. § 3.159 (2009). Here, the notification obligation was met by letters from the RO to the Veteran dated in December 2005 and March 2006. The letters advised the Veteran of VA's and his obligations in the development of evidentiary evidence, and of what information and evidence was necessary to substantiate the claims. See Quartuccio v. Principi, 16 Vet. App. 183 (2002). The March 2006 letter advised the Veteran as to how disability ratings and effective dates are assigned. While complete notice was not provided prior to the initial adjudication in this matter, a July 2006 Statement of the Case (SOC) and a September 2010 supplemental SOC readjudicated the matter after he received complete notice, and had opportunity to respond, and after further development was completed (curing any notice timing defect).. The Veteran's service treatment records (STRs) and pertinent post-service treatment records are associated with the claims file. He was afforded a VA gastrointestinal diseases examination in January 2010; the examination is adequate for rating purposes (as will be discussed in greater detail below). The Veteran has not identified any pertinent evidence that is outstanding. VA's duty to assist is met. Legal Criteria, Factual Background, and Analysis Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). In general, service connection requires (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in- service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). Certain chronic diseases (to include duodenal/peptic ulcer) may be service connected on a presumptive basis if manifested to a compensable degree within a specified period of time following discharge from active duty (one year for duodenal ulcer). 38 U.S.C.A. § 1112; 38 C.F.R. §§ 3.307, 30309. A disease may be service connected if shown to be of a chronic nature in service, or if not chronic, then seen in service with continuity of symptomatology demonstrated after discharge. 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 494-97 (1997). Disorders diagnosed after discharge may still be service connected if all the evidence establishes that the disorder was incurred in service. 38 C.F.R. § 3.303(d); Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). A layperson is generally not capable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183, 186 (1997). Lay evidence may however be competent evidence to establish incurrence. See Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (e.g., a broken leg), (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, competent medical evidence is necessary where the determinative question is one requiring medical knowledge. Id. The Board notes that it has reviewed all of the evidence in the Veteran's claims file, with an emphasis on the evidence that is relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss in detail every piece of evidence. See Gonzales v. West, 218 F, 3d, 1378, 1380-81 (Fed. Cir. 2000) (VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the evidence as deemed appropriate, and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as to the claim. The Veteran contends that he has peptic ulcer disease that began during his active duty service. The Veteran's STRs show complaints of abdominal pain in service. In August 1951 he was hospitalized for epigastric discomfort and syncope. Extensive evaluation at that time, including a GI series, did not reveal ulcer disease (although standard ulcer therapy improved the Veteran's symptoms). Postservice treatment records show that in July 1981 the Veteran was hospitalized, at which time an upper GI study was interpreted as "abnormal mucosa of the duodenal bulb but no active ulcers demonstrated". Following an EGD, the diagnosis was moderately severe antral gastritis and severe duodenitis with multiple superficial ulcers. Postservice treatment records since 1981 are silent for any diagnosis of, or treatment for, peptic ulcer disease. On January 2010 examination, the Veteran reported no epigastric pain, hematemesis, melena, nausea, or vomiting. He reported periodic substernal "heartburn" approximately every three days which was effectively treated with Rolaids. He also took Tagamet and Gaviscon as needed. The examiner noted a history of prostate cancer status post radical prostatectomy but no GI neoplasm. Upon physical examination, there was no tenderness and there were no signs or symptoms of anemia. The abdomen was soft, nontender, and nondistended, with no masses or organomegaly. The diagnosis was dyspepsia, effectively treated with Rolaids. There were no signs or symptoms indicative of peptic ulcer disease. After a complete physical examination and a thorough review of the Veteran's records, the VA examiner opined, "It is not thought that the Veteran has peptic ulcer disease and it is not thought that the Veteran's dyspepsia is related to his symptoms requiring hospitalization at Fort Bliss, 08/28/1951, or his symptoms with the esophagogastroduodenoscopy findings while in Shannon Memorial Hospital, 07/10/1981." The examiner explained that the Veteran has "absolutely no signs or symptoms of peptic ulcer disease and by his own admission has not had recurrence of the pain which prompted hospitalization at Shannon" in 1981. The examiner added that the Veteran currently takes aspirin and dipyridamole which "would be contraindicated with peptic ulcer disease". The examiner also noted that there is no recent endoscopic evidence that the Veteran has asymptomatic peptic ulcer disease. Initially considering the Veteran's allegation that he had the onset of duodenal ulcer disease in service the Board observes that while he was evaluated for gastrointestinal complaints, and specifically to determine whether he had ulcer disease, the extensive studies, including a GI series did not reveal duodenal/peptic ulcer. Furthermore there is no competent (medical) evidence of duodenal ulcer being manifested in the first postservice year. While the Veteran may be competent to establish by his own accounts (and the Veteran has no reason to question the accounts) that he had various gastrointestinal system symptoms, the diagnosis of ulcer disease is a complex medical question beyond lay observation. This is not a situation where the diagnosis may be established by lay evidence: the disability is not one capable of lay observation; the Veteran is not reporting a contemporaneous diagnosis (as there is no firm diagnosis of active ulcer disease; and the Veteran does not describe symptoms supporting a later diagnosis (as ulcer disease is not diagnosed). See Jandreau v. Nicholson, 492 F.3d, 1372 (Fed. Cir 2007). Consequently, service connection for peptic ulcer disease on the basis that it became manifest in service (and persisted) is not warranted. As for further analysis in the claim of service connection, it is noteworthy that an initial threshold requirement here (as in any claim seeking service connection) is that there must be competent evidence that the Veteran has (during the pendency of the claim has had) the disability for which service connection is sought, i.e., ulcer disease. See 38 U.S.C.A. § 1110. Thorough, excluding an invasive procedure (upper endoscopy) which the Board has declined to request as it presents potential risk to the Veteran, evaluation has failed to find evidence that the Veteran has duodenal ulcer disease. As was noted above, he is not competent to establish such diagnosis by his own opinion. Without evidence of current ulcer disability there is no valid claim of service connection for such disability. Brammer v. Derwinski, 3 Vet. App. 223 (1992). The preponderance of the evidence is against this claim; accordingly, it must be denied. ORDER Service connection for peptic ulcer disease is denied. ____________________________________________ George R. Senyk Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs